A State-Mandated, Detailed Autopsy Consent Does Not Impact the Autopsy Rate at an Acedemic Medical Center
C Pang, L Watts, CA Kiriakos, MJ O'Brien, CD Andry. Boston Medical Center, Boston, MA
Background: Autopsy rates at our institution have been constant for over a decade and have remained higher than the reported national level. Recent revision of state law required that our autopsy permission form be expanded to include mandatory information to provide informed consent. This included questions regarding restriction of an autopsy, organ and tissue disposition, donation of organs and tissues for research and education. When this form was implemented, concern was expressed that this lengthier, detailed consent would reduce the autopsy rate. The aim of the study is to report on whether a more extensive consent form dissuades families from agreeing to an autopsy.
Design: Autopsy rates from 1996 to 2008 were calculated. Rates before and after implementation of the revised autopsy form were then compared. In addition, 123 autopsy authorization forms, signed between 2007 and 2009 were reviewed. The answers given for each inquiry field were recorded and were used to calculate rates of response.
Results: Autopsy rates over the past 13 years have remained between 19-26%. Of the autopsy consent forms reviewed, families requested an unrestricted autopsy 68% of the time. 32% asked that tissues not processed for histology, should be returned to the patient's body for disposition. Permission to retain organs in the department for teaching and research was given 60% of the time. 28% of families excluded the patient brain from the autopsy. Of patients' whose brain was included in the autopsy, 23% of families declined donation for research. Special requests were made 30% of the time including: the date the body was to be returned; inspection of specific organs; specifying who to contact with results; plans for open casket viewing; requests for pre-autopsy viewing; requesting autopsy and skeletal x-rays. Permission to test the patient for HIV/Hepatitis B, in the event that a technician was injured, was given 100% of the time, as was permission to photograph the patients' autopsy.
Conclusions: The implementation of a detailed informed consent has not reduced the autopsy rate at our hospital. A third of families agreeing to the procedure chose to limit the autopsy, and less than a third asked for organs to be returned to the patient. A majority of families gave permission for organ and tissue retention for teaching and research. An expanded autopsy consent allows next-of-kin to make fully informed decisions about an autopsy procedure and the disposition of their family member's remains.
Monday, March 22, 2010 2:45 PM
Platform Session: Section G, Monday Afternoon